Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients

Autor: Fabienne Pessione, Marc Faraggi, R. Gourgon, Michel Dahan, Amir Kolta, B. Legallicier, Dominique Le Guludec, Dominique L. Himbert, F Mignon, Beatrice Viron
Rok vydání: 1998
Předmět:
Male
Vasodilator Agents
medicine.medical_treatment
Coronary Disease
Coronary Angiography
Scintigraphy
renal mortality
Coronary artery disease
chronic dialysis
Myocardial infarction
Thallium
diabetes
medicine.diagnostic_test
Dipyridamole
Middle Aged
Prognosis
myocardial infarction
Nephrology
cardiovascular system
Female
revascularization
Radiology
Hemodialysis
medicine.symptom
coronary artery disease
medicine.drug
Adult
medicine.medical_specialty
chemistry.chemical_element
non-invasive imaging
Asymptomatic
Predictive Value of Tests
Renal Dialysis
medicine
Humans
cardiovascular diseases
Tomography
Emission-Computed
Single-Photon
business.industry
Reproducibility of Results
medicine.disease
Survival Analysis
chemistry
Angiography
Exercise Test
Kidney Failure
Chronic
stress-thallium imaging
business
Follow-Up Studies
Zdroj: Kidney International. 54:255-262
ISSN: 0085-2538
Popis: Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients.BackgroundNon-invasive detection of coronary artery disease in dialysis patients, a major cause of mortality, often remains difficult. The aim of the study was to test the diagnostic and prognostic accuracies of combined dipyridamole-exercise thallium imaging in dialysis patients.MethodsDipyridamole-exercise thallium imaging and coronary angiography were both performed prospectively in 60 asymptomatic hemodialysis patients who were followed up, long term, by recording any major coronary event.ResultsCoronary angiography was abnormal in 13 patients (21%), and there was abnormal thallium uptake in 17 patients. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of thallium to detect a coronary artery disease were 92, 89, 71, 98 and 90%, respectively. After a median follow-up of 2.8years, 12 patients experienced at least one major coronary event (4 cardiac deaths, 5 myocardial infarctions and 3 revascularizations). Eight of the 17 patients with abnormal thallium uptake (47%) suffered a coronary event, compared to only 4 of the 43 patients (9%) with a normal thallium uptake (P < 0.001). The positive prognostic predictive value of thallium imaging was 47% and its negative predictive value was 91%. The probability of survival free of coronary events was significantly higher in patients with normal thallium uptake than in those with abnormal thallium uptake (crude risk ratio 7.6; P < 0.001) even after adjustment for several risk factors for cardiovacular disease (adjusted risk ratio 9.2; P < 0.005).ConclusionIn dialysis patients, combined dipyridamole-exercise thallium imaging is an acurate method for detecting coronary stenosis and for predicting future coronary events.
Databáze: OpenAIRE
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